By Patty Khuly, VMD, MBA

When, I, as a ninth-grader newly matriculated to a Catholic school for girls, learned I would be required to endure the sacrament of confession on a regular basis, I took my grievance over the prospect all the way to the high school principal. “I believe it’s inappropriate for a middle-aged man to hear the confessions of a 14-year-old girl,” I protested. “No way will I do it.”

Keeping secrets

I felt much the same way when considering this column, which a colleague suggested I submit for publication. No way can I tell tales confided to me by way of collegial commiseration, even in a veterinary forum like this one. It is potentially unprofessional. However, then I read a few very public veterinary confessions and concluded the lies I tell in my veterinary life are in no way unique to me or my practice.

Most of the various untruths we tell clients and colleagues, while by no means identical, follow similar patterns. In other words they kind of rhyme, revealing patterns of misrepresentation shaped by the many stresses we routinely endure as veterinary professionals. Wouldn’t it be helpful to expose these stressors, even if they do not always reflect favorably on us?

The question for me when considering this column came down to whether recounting these “lies” runs the risk of “exposing” our profession to unnecessary reputational risk. Might some readers misconstrue these accounts as evidence of our profession’s nefarious wrongdoings? To be sure, some laypersons would. Alas, the “truth” is always more complicated.

Everyone is guilty

The way I see it, we all lie. We do so every day when presenting our veterinary findings to the public. After all, it is practically in our job description that we redirect our clients’ attention to the facts we believe serve our patients’ best interest and minimize those that might not. Call it obfuscation. Some would even call it misdirection. Most veterinarians, I am certain, would call it advocacy.

1) Consider the following common scenarios where we consciously or subconsciously misrepresent the nature or severity of our patients’ conditions:

• When we downplay our feline patient’s FeLV because we do not want our client to refuse the full-mouth extraction her severe stomatitis necessitates, we believe we are doing right by our patient … but we are also spinning the truth.
• When you have a hammer, everything looks like a nail; meaning we often pick and choose which conditions to spotlight in a patient with multiple diagnoses, weighting those we are more comfortable treating or know we can successfully manage without referring. Sometimes we even put our finger on the scale when it comes to conditions we can treat most profitably.
• We may even misrepresent the seriousness of our patient’s illness (so our clients do not immediately elect euthanasia in a knee-jerk fashion), preferring to present the information gradually and gently.
• Sometimes we misrepresent the capacity of our industry to treat certain conditions, as when we fail to encourage chemotherapy for a lymphoma patient or surgery for a patient with a debilitating cruciate ligament tear. Again, this is not often done nefariously. In fact, most of us would do so only by way of sparing our clients from financial distress when we believe we know what they can and cannot afford.

2) Some of our “lies” are often intended to shield our clients from worry or unnecessary grief, but also to buy us time or spin the optics to our benefit:

• When we tell them the lab hasn’t reported anything yet while the (almost) complete report is telling us lymphoma is the only reasonable possibility, we’re effectively putting off the inevitable and procrastinating on delivering a hard truth. However, we are also ensuring we get that final pathologist’s assessment of that PARR … just to be 100 percent sure, but also to spare them the unnecessary details of the process (and us from having to deliver a time-sucking blow-by-blow).
• When we clearly see a mass in the abdomen on X-rays, but elect to wait until the radiologist confirms before divulging the truth. We delay the pain and can deliver the news all at once, denying them the uncomfortable phase of grievous uncertainty.
• When the seemingly stable patient was already dead when we arrived in the morning, we’ve been known to claim they died only moments before our telephone call. Worse, we’ve said they were currently in the process of passing and could they come over as soon as possible (knowing they were unlikely to make it in before evidence of an hours-old death became obvious). A beloved pet dying alone in a hospital is the last thing we want owners to picture.

In the interest of self

Others are undoubtedly self-serving, albeit sometimes for the “right” reasons:

• I will not offer you a written prescription to buy online products. It is considered unethical to do so given the proliferation of online gray markets. Another similar such “lie:” I cannot ethically write a prescription for a non-veterinary product when a veterinary product is available, even though your dog weighs 100 lbs and the liquid-version veterinary products are priced 20 times higher than the chemically identical generic tablet. Some may call these completely defensible, ethical gray areas, but the upshot is the same: financial self-interest.
• We often bend the reality to suit our pocketbooks, as when some elect to vaccinate annually or even semi-annually when manufacturers clearly state longer durations of immunity on their labels. I am not saying I agree with the practice, but I do understand where it is coming from.
• My kids are sick and I have to get home so I could not possibly wait for you. A multitude of variations on this theme may be self-serving and essentially “uncool” to do to a patient who you know darn well you would serve better than the overstressed ER team, but they’re also very admirably self-preserving in many cases.
• A colleague once confessed to lying about still caring for a signed-over, abandoned kitten after he had passed. She was on a faraway outing with friends (with the pro-bono patient in tow) and could not return should the emotionally invested finder of said kitten expect to see him right away. So she carried the deceased patient around in his carrier for hours before her friends were willing to drive her back home, thereby proving dedication and lying are not mutually exclusive. Only happens in veterinary medicine, right?

Sure, some might argue that recounting these true-crime scenarios might readily serve as ammunition for those who criticize veterinary medicine; they depict veterinarians as self-serving evildoers reveling in telling lies so we can get away with negligent misdeeds or charge our clients for services rendered under false pretenses.

Ultimately, it is more nuanced than that, isn’t it? Given our lies reveal the reality of our many challenges (professional, stress-wise, financial, or otherwise), inter-collegial transparency benefits us emotionally, especially when presented in a forum like this one. After all, this is not USA Today or Cat Fancy… and you are not middle-aged men considering the confessions of a teenage girl.

Patty Khuly, VMD, MBA, owns a small animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.